Hygiene Improvement Project: Country Work

Uganda: Improving Hygiene for Home-Based Care of HIV+ Individuals

(Image: Water transport counseling card)
The focus of HIP in Uganda has been to develop and operationalize the behavior change component of the Government of Uganda's Ten-Year Improved Sanitation and Hygiene Promotion Financing Strategy. On key activity has been implementing activities to address poor WASH practices in homes of HIV positive individuals, including addressing the urgent need for improved WASH practices in Home Based Care (HBC).  Although HBC providers receive training in many aspects of care and support at the household level, including training in the principles of basic WASH, little emphasis and/or detailed information has been given about how HBC providers can help household members to overcome, or change, the many daily obstacles to improved WASH behaviors in the home.

To address this gap in Uganda, HIP, in partnership with Plan Uganda, the Government of Uganda, and the Uganda Water and Sanitation Network (UWASNET), have developed training and outreach worker materials that are based on the principle that WASH practices in the household can be improved - that is, new practices can be adopted and current practices can be modified or changed in small ways that are acceptable/feasible to the householder and that can be carried out by households. The materials include a Training Manual for HIV/AIDS home-based care providers (text-based);Participant’s Guide for the home-based care staff supporting people with HIV/AIDS  in their homes (mostly text-based); Assessment Tool (pictorially-based); and Counseling Cards (pictorially-based).

Peru: Facilitating household behavior change for safer water

(Image: household diagnostic tool for water handling)

The USAID-funded Healthy Communities and Municipalities (HCM) Project partnered with HIP in Peru to develop a program to generate behavior change at the household level that would lead to point-of-use water treatment through chlorination, solar disinfection, or boiling, as well as handwashing at critical moments and proper feces disposal. Research was conducted to test the water quality from the various water sources in the communities and within households. All the water sources were found to be contaminated at levels dangerous for consumption. Based on the findings, a household water treatment system using a chlorine-based approach was recommended. This presented a unique challenge, since a chlorination product was not available in Peru. Therefore, the project team, with the assistance of the CDC, designed a chlorination protocol using available household chlorine bleach products. An intervention was planned and training and user materials developed. Master trainers, who were members of local neighborhood councils, district level government, and health post staff, received intensive training to increase their competencies as behavior change agents regarding water, sanitation, and hygiene behaviors and to ensure sustainability beyond the project lifespan.

A pilot was carried out in the Curimaná District of the Ucayali Region of Peru and then scaled up to six additional regions. Success of the intervention was evidenced by a significant positive shift—from 48.3 percent to 65.9 percent—in the key indicator of number of children under the age of two who are consuming safe water. Learn more through a report on Achieving Household Point-of-Use Water Treatment in Amazonian Peru.

Uganda: Supporting sanitation marketing

The Manoff Group provided modest technical support to HIP for sanitation marketing work in Uganda. Formative research revealed households' barriers and motivations to improved sanitation practices, and these results led the project to consider engaging new partners: Technical training institutions became key actors after research revealed that the latrine design preferred by the target group of consumers could only be built by trained masons who currently lacked the necessary skills. The partnership with technical training institutes ensured a continuous supply of trained service providers and opened up the possibility of extending the program to other areas of the country, since the students came from many other districts.


Madagascar: Promoting feasible hygiene behaviors for families

Research was completed for a series of Trials of Improved Practices (TIPs) to explore the extent to which 100 families in four regions could implement small doable hygiene behaviors in their households. The results have been incorporated into plans for improved hygiene promotion efforts among HIP Madagascar partners and for a community-based behavior change strategy in water, sanitation, and hygiene. The HIP Madagascar Team held a series of behavior change strategy validation workshops with key partners in each region. The strategy will be tailored to meet varying regional needs. In addition, a national hygiene campaign is under way with HIP support and partnerships with the host-country government and implementing partners.

West Africa Water Initiative (WAWI)

Three behavior change (BC) specialists work with WAWI in Ghana, Mali, and Niger. In Mali, initial support focused on planning National Hand Washing Day. In Niger, the BC specialist served as a liaison between UNICEF and the WASH partners in Maradi in support of the fight against cholera. In Ghana, the BC consultant worked with UNICEF to define a BC strategy for guinea worm and co-facilitated a workshop on community-led total sanitation, in addition to planning a BC intervention with World Vision.